Gastric Antral Vascular Ectasia (GAVE), commonly known as “watermelon stomach,” is a rare condition affecting the stomach lining. It causes chronic gastrointestinal bleeding, which can lead to significant blood loss and impact overall health.
What is Watermelon Stomach?
Watermelon stomach, or Gastric Antral Vascular Ectasia (GAVE), involves the abnormal dilation of small blood vessels in the stomach lining. These fragile, enlarged vessels are typically located in the antrum, the lower part of the stomach. During an endoscopy, the stomach lining often shows distinct red, stripe-like lesions, resembling a watermelon, which gives the condition its name. These vessels are prone to rupture and bleeding.
Common Symptoms
Individuals with watermelon stomach often experience symptoms from chronic blood loss. The most frequent is iron deficiency anemia, causing fatigue, shortness of breath, and pale skin. This anemia results from slow, persistent bleeding from fragile stomach blood vessels.
Gastrointestinal bleeding can also appear as black, tarry stools (melena) or, less commonly, vomiting blood (hematemesis). Abdominal pain or nausea are other potential, though less frequent, symptoms. Some individuals with watermelon stomach may not experience any noticeable symptoms.
Underlying Causes
The cause of watermelon stomach is not fully understood, but it is often seen with other systemic health conditions. It links to autoimmune diseases like scleroderma and lupus, and connective tissue disorders. Chronic liver diseases, including cirrhosis, are also associated with GAVE, present in up to 30% of patients with liver failure.
Chronic kidney disease and certain heart conditions can also relate to watermelon stomach development. These illnesses may contribute to changes in blood flow or increase blood vessel fragility in the stomach lining. Hormonal factors and chronic inflammation in the stomach lining are also suggested contributors.
How it is Diagnosed
Diagnosing watermelon stomach involves an upper endoscopy, also known as an esophagogastroduodenoscopy (EGD). During this procedure, a flexible tube with a camera is inserted through the mouth to visualize the esophagus, stomach, and beginning of the small intestine. The characteristic “watermelon” appearance, with red, linear stripes or spots on the stomach lining, confirms the diagnosis.
A biopsy, taking a small tissue sample for microscopic analysis, may be performed in some cases. Blood tests are also conducted to assess for iron deficiency anemia, a common consequence of the chronic bleeding.
Treatment Approaches
Treatment for watermelon stomach focuses on controlling bleeding and managing symptoms. Endoscopic therapies are the main approach, with Argon Plasma Coagulation (APC) being a common method. APC uses ionized argon gas and an electrical current to burn and seal fragile, bleeding blood vessels in the stomach lining. This minimally invasive procedure coagulates affected tissue and prevents further blood loss.
Other endoscopic techniques, such as endoscopic band ligation (EBL) and radiofrequency ablation (RFA), may be used if APC is not effective or in cases of recurrence. EBL involves placing small elastic bands around enlarged blood vessels to cut off their blood supply and promote scarring. Supportive treatments include iron supplementation for anemia and, in some instances, blood transfusions for severe blood loss. Managing any underlying associated conditions, like liver or autoimmune diseases, can also help minimize GAVE symptoms. Surgical removal of the affected part of the stomach is a more invasive option, typically reserved for severe cases unresponsive to other treatments, though this is rare.